Healthcare Provider Details

I. General information

NPI: 1710121942
Provider Name (Legal Business Name): FLEETA BURGESS APN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2009
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 NY-17K
MONTGOMERY NY
12549
US

IV. Provider business mailing address

145 MARION DR
WEST ORANGE NJ
07052-3301
US

V. Phone/Fax

Practice location:
  • Phone: 845-406-4992
  • Fax:
Mailing address:
  • Phone: 973-395-3948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00191200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: